基于肺体表投影的腧穴分类及针刺后气胸的预防

Classification of Acupoints Based on Lung Surface Projection and Prevention of Pneumothorax after Acupuncture

[目的]对易造成气胸的腧穴进行分类和归纳,以期针灸工作者,尤其是针灸初学者更科学地掌握腧穴的针刺操作,预防气胸发生。[方法]为了更好地预防针刺后气胸的发生,以腧穴定位和针刺操作为主要着眼点,根据肺体表投影及经穴的分布特点,将可能造成气胸的腧穴分成4大类,基于此从针刺操作角度、方向、深度三要素总结4类穴位的操作要点,并结合文献分析可能引起针刺后气胸或增加发生概率的其他危险因素。[结果]第一类位于肺体表投影内的腧穴,包括8条经、39个腧穴及1个经外奇穴,针刺操作要点在于不能直刺深刺。第二类位于肺体表投影边缘的腧穴,包括4条经、5个腧穴及11个经外奇穴,针刺操作要点在于不能朝肺深刺。第三类位于肺体表投影附近,包括6条经和10个腧穴,针刺操作要点在于不能朝肺深刺。第四类位于肩胛骨之上的腧穴,包括2条经和4个腧穴,针刺操作要点在于以直刺为主。文献分析发现,肺部基础疾病可增加针刺后气胸风险。[结论]在准确掌握肺脏解剖和经穴定位的基础上,严格规范针刺操作,了解患者肺部基础疾病,可最大程度地避免针刺后气胸的发生。

[ Objective] To classify and summarize the acupoints easy to cause pneumothorax, so that acupuncture workers, especially acupuncture beginners can master the acupuncture operation more scientifically to prevent the occurrence of pneumothorax. [Methods] In order to better prevent the occurrence of pneumothorax after acupuncture, this paper took acupoint positioning and acupuncture operation as the main point, according to the lung surface projection and the distribution characteristics of the meridian point, divided the acupoints which may cause pneumothorax into four categories, based on the above, from the angle of acupuncture operation,direction and depth, summarized the operation points of the four types of acupuncture points. Other risk factors which may cause pneumothorax after acupuncture or increase the probability of occurrence were also analyzed through the literature. [Results] The first category of acupoints is located in the lung surface projection, including 8 meridians, 39 acupoints and 1 extra-acupoint, and the key point of acupuncture operation is not to needle directly or deeply. The second category of acupoints is located at the edge of the lung surface projection, including 4 meridians, 5 acupoints and 11 extra-acupoints, and the key point of acupuncture operation is not to needle towards the lung. The third category is located near the lung surface projection, including 6 meridians and 10 acupoints, the key point of acupuncture operation is not to needle towards the lung. The fourth category of acupoints is on the scapula, including 2meridians, 4 acupoints, and the key point of acupuncture operation is direct acupuncture. The literature analysis finds that the underlying lung disease can increase the risk of pneumothorax after acupuncture. [Conclusion] On the basis of accurately grasping the lung anatomy and acupoint positioning, strictly standardizing the acupuncture operation, and understanding the underlying lung diseases of patients can avoid the occurrence of pneumothorax after acupuncture to the greatest extent.